Impact of Physical Activity on Post-TBI Depression in Adults: A Systematic Review

Traumatic brain injury (TBI) represents the highest incidence of common neurological disorders. Depression, a common symptom after traumatic brain injury, delays recovery and decreases quality of life. The purpose of this systematic review was to determine the impact of physical activity on depressive symptoms for individuals who sustain a TBI. A literature search of PubMed, ProQuest, CINAHL (Cumulative Index of Nursing and Allied Health), and Springer-Link was conducted. Selection criteria: adults age 18 and older who sustained a TBI and received any type of physical activity intervention with at least one standardized outcome measure of depression. Each study was independently assessed for methodological quality by two reviewers who came to consensus using Oxford Centre for Evidence Based Medicine levels of Evidence (2011). A total of 246 articles were screened for eligibility and five articles met selection criteria. All studies administered physical activity interventions using 30-60 min of aerobic exercise three to five times per week at 50-70% age-predicted maximal heart rate with durations ranging from 8 to 24 weeks. All studies reported reductions in depressive symptoms after interventions. No adverse events were reported. Performance of moderate intensity aerobic exercise (both land-based and aquatic) appears to have the most benefit in lowering depressive symptoms in adults. Clinically meaningful changes in Beck's Depression Inventory (BDI) mean scores and Hamilton Depression Scale (HAM-D) improvements exceeded the minimal clinically important difference for each.